Early cancer detection strategies can ease healthcare disparities in Europe

09 November 2016

Tit Albreht

Boosting cancer control in Europe may yet find tenable options by using effective early cancer detection strategies and timely screening instead of a continued and heavy reliance on expensive technology.

“The challenge of economic inequality is a reality that realistically cannot be overcome by directives or by any political decision or enforcement,” said Dr. Tit Albreht, Associate Professor of Public Health at the Department of Public Health of the Medical Faculty in Ljubljana (SL) and coordinator of the Joint Action Cancer Control (CanCon) which provides health policy support and advice to cancer control strategies to the European Union (EU) and its member states.

Albreht, who will speak on healthcare developments and policy-making at the upcoming 8th European Multidisciplinary Meeting on Urological Cancers (EMUC16) to be held in Milan (IT) from 24 to 27 November, said healthcare access among the EU member countries is not at par due to disparities in income, financial resources and healthcare priorities.

“One need to take into account that GDP in Luxembourg or Sweden is around 45,000 euros per capita and that of Bulgaria is around 5,600 euros and this difference means that there will be differences in access, availability of advance technologies, innovations and research,” said Albreht.

Thus, patients with deep pockets in low income countries tend to seek expensive healthcare in countries with more advance healthcare technologies. But Albrecht noted that this migration of patients across do not contribute to improving healthcare policies in their countries of origin.

Treatment across borders

“Mobility of patients based on the directive does not solve this problem at all because the pot money from which the reimbursement of patients should be taken from is the same. Another important problem is that in the eastern and south-eastern Member States, the burden of cardiovascular diseases (CVD) is still much more important than cancer and it is a matter of public health and public health policy priorities as well. In other words, cancer care cannot “eat up” all of the health budgets,” Albreht explained.

With limited resources in many countries across the European continent, cancer control remains a top priority with the need for durable solutions becoming more urgent.

He pointed out: “We need to stress the importance on good screening and proven early detection strategies and programmes and not make these countries rely so heavily on technology, which they cannot afford or their system cannot equitably afford.”

As coordinator of the Joint Action Cancer Control (CanCon), Albrecht also mentioned that CanCon will soon come up with its EU Joint Action which will propose a comprehensive list of recommendations. “It will not be a directive but is a selection of good practices and implementation options for Member States to learn from and potentially acquire… Practically all of the topics are relevant for urological cancers; hence there will be many opportunities to explore options to improve cancer care and control in the field of urological cancer in the future,” he said.

“More importantly, we will try to propose a more comprehensive approach to the economics of cancer and health technology assessment (HTA) beyond pharma and medications,” he noted.

Survivorship programmes

At the EMUC where Albreht will tackle the topic “EU joint action on cancer control – improving prostate cancer diagnosis and care,” he will focus on current developments and potentials in policy-making, particularly with regards urological malignancies which are frequently encountered by doctors as Europe’s elderly populations steadily expand in recent years.

“We need to look into the development and maintenance of good programmes of early detection of prostate cancer while considering the potential for either the introduction of overt screening programmes or abandoning such an idea,” he said. “There is also the importance of the approach to survivorship, which the patient has to be prepared for and for which a clear plan needs to be drafted soon after the diagnosis has been positively established.”

Cancer control policy experts say that having a structure of support and clear communication for cancer patients are essential since these directly contribute to the patient’s capacity to make sound treatment decisions and dispel unfounded fears. Effective communication between patients and their doctors is particularly crucial in the light of the widespread perception regarding over-diagnosis and over-treatment.

“Early detection of prostate cancer has brought about more attention to this disease, enhanced the diagnostic setup and provided for more diversity in approaches and treatment. This has definitely been the positive side of this development.” Albreht said. “On the other hand, we are dealing with over-diagnosis and over-treatment as one of the consequences of these developments.”

Best practices and insights

With regards the EMUC which is known as a professional venue for knowledge exchange and sharing, Albreht said these meetings play a significant role since not only does a multidisciplinary meeting opens up communication channels it also anticipates future challenges and possible solutions to healthcare and medical issues.

“Through inter-disciplinary collaboration we can deal with challenges in introducing new achievements in patient care, patient pathways and guidelines. There is also the opportunity to setting up professional and scientific priorities, including the agenda for the future,” he said.

He also mentioned that there are important urological malignancies that would require significantly more attention.

“We have bladder cancer and renal carcinoma, where not so many advances have been observed and patients are still often diagnosed with advanced disease. Obviously, ageing of populations is contributing to urological cancers and older populations will gradually require enhanced medical and nursing attention with respect to cancers as well, not only with respect to CVD and neurological problems,” Albreht added.

At the three-day EMUC, seven sessions will tackle a wide range of issues and unresolved controversies regarding the diagnosis and treatment of urological cancers in the prostate, bladder and kidney. From pathology, genetics, recurrent and high-risk diseases, targeted therapies, personalised treatment to risk factors, the meeting will focus on the impact of new treatment and medical strategies.

The EMUC will be preceded by the 2016 EMUC Symposium on Genitourinary Pathology (ESUP) on November 24, Thursday, and the annual and 5th Meeting of the EAU Section on Urological Meeting (ESUI) on the same day.

For other details on EMUC16 scientific programme see the comprehensive overview.